[Medical procedures carried out by rescue team at multiple body injury victims of accidents]. / Procedury medyczne podjete przez zespol specjalistyczny u ofiar wypadkow z obrazeniami wiecej niz jednej okolicy ciala.

UNLABELLED: Medical emergency ambulances with physician are the only that could give qualified medical aid to victims of incidents at the theatre and while transportation. THE AIM OF THE STUDY: was to check whether the pre-hospital medical care at victims of accidents in aspect of executed by rescue team medical procedures while actions to incidents. MATERIAL AND METHODS: It was made the retrospective comparative statistical analysis of protocols from actions to incidents took by rescue team in groups of victims with multiple (MBl) and isolated body injuries (IBI) and executed medical procedures during following 48 months. RESULTS: The rescue team took 11 200 actions including 1539 incidents (13.7%). MBls were found to 407 victims (26.4%). Men were more frequent (n = 263; 64.6%) then females, and Injury Severity Score (ISS) was 17.3. These data'were compared to group of 1132 IBI victims (73.6%), with men victims of 730 (64.5%) and mean ISS of 4.1 points. Comparing executed medical procedures between group of victims with MBI vs IBI: advice was given to 175 persons (43%) vs 500 (44.2%), pharmacotherapy was introduced to 43 (10.6%) vs 151 (13.3%), dressing needed 72 wounded (17.7%) vs 341 (30.1%), immobilizing to 83 (20.4%) vs 122 (10.8%) and advanced rescue procedures needed 34 (8.4%) vs 18 (1.6%) confirming statistically difference. The decease on place of event as direct complication of injury was recognized at 47 MBI victims (11.5%) vs 17 IBI (1.5%). 360 MBI victims (88.5%) vs 1115 IBI (98.2%) were given help on scene, of which 299 (83.1%) vs 837 (73.9%) needed hospital treatment, but 7 of them (2.3%) died after arriving at Emergency Department. Detailed analysis of 1016 medical procedures taken at 238 victims with MBI (66.1%) vs 1659 at632 victims with IBI (55.8%) was introduced. Detailed analysis proved procedures to victims with multiple body injures (MBI) were of significant difference to other harmed specially to giving oxygen (32.8% vs 16.5%), monitoring (21% vs 7.3%), pharmacotherapy (63% vs 33.4%), immobilizing (41.6% vs 19.5%/), folded procedures including drugs, fluids, dressing and immobilizing together (63.9% vs 26.7%), cardiopulmonary resuscitation (8.3% vs 1.6%). CONCLUSIONS: The multiple body injuries were recognized to one of fourth victims of incidents of which traffic accidents and beating were predominant causes. Multiply body injuries (MBI) victims need more frequent advanced live support (resuscitation) or compound medical aid on scene. Resuscitation was independent on kind and heaviness of injury to victims of incidents.

[Thoracic aorta dissection a difficult diagnostic problem at home--case reports]. / Rozwarstwienie aorty piersiowej jako trudny problem diagnostyczny w domu chorego--opisy przypadków.

UNLABELLED: Aortal dissection is one of the most life threatening complications of hypertension. The sudden, strong chest pain is leading symptom of disease, that is also frequent cause to call emergency. The aim of the study was to present diagnostic difficulties in case of aortic aneurysm dissection during giving aid by rescue team at home. RESULTS: There were described three evidence cases of aortic aneurysm dissection. The wide range of clinical symptoms as well as diagnostic difficulty in this state of threat of life was showed. The attention was turned on necessity of diagnostic procedures at hospital conditions. Chest computer tomography was performed to put proper diagnosis. The dramatic course and coincidence of other diseases makes it difficult for rescue team to introduce proper diagnosis and treatment at home. The introduced proceeding was limited to save transportation or required advanced live support before it. CONCLUSIONS: The recognition of aortic dissection is a very difficult task for emergency physician at scene. Patients, that present symptoms of acute dissection of thoracic aorta, should have quickly diagnosis and treatment at cardiology department.

[Comparison of patients over 70 years old operated for hernia and cholecystolithiasis in the years 1990-1994 and 2001-2002]. / Porównanie chorych w wieku powyzej 70 lat operowanych w latach 1990-1994 oraz w latach 2001-2002 z powodu przepukliny i kamicy pecherzyka zólciowego.

UNLABELLED: THE AIM OF THE STUDY was assessment of this phenomenon as observed in the past period of 1990-2002 among patients from the surgical department. In the years 1990-1994 the percentage of persons over 70 years who had been operated upon rose from 14 to 25% with an average of 14.7%. MATERIAL AND METHOD: Patients operated for inquinal and femoral hernias and for cholecystolithiasis in the years 1990-1994 were assessed and compared with those operated in the years 2001-2002 with regard to the rate of postoperative complications. RESULTS: It was found that the total percentage of patients over 70 years old operated upon became reduced from 14.7 to 9.7% and that it even fell from 34 to 17% in persons past 80 treated for hernia. The marked improvement of the results of the treatment of cholecystolithiasis was attributed to the introduction of the laparoscopic method of operation. In the group of patients treated with the above method the percentage of persons over 80 years old also fell from 19.2 to 12.5%. CONCLUSION: This is proof that current demographic data do not always find their reflection among persons operated upon and that they do not bear aggravatingly upon the results of treatment.

[Laparoscopic cholecystectomy--the method of choice in the elderly]. / Cholecystektomia laparoskopowa metoda z wyboru u osób w wieku podeszlym.

The aim of the study was the comparison and assessment of the results of gallbladder excision performed with the classical and laparoscopic methods in persons after age of 70. A total of 242 patients with mean age of 76.1 years operated on in the years 1999-2002, were analysed. 150 of them were operated with the laparoscopic and 92 with the classical methods. The frequency of postoperative--surgical and general--complications and the presence of concomitant diseases associated with old age were compared. Laparoscopic procedures are distinguished for an almost six fold decrease in the percentage of complications (6 vs. 35%) loaded comparably with concomitant diseases. Patients operated with laparoscopic methods had suffered from cardiac infarctions twice as often in their past history (17 vs. 8%). The method of laparoscopic gallbladder excision proved to be beneficial also in persons of advanced age.